The word “core” and “core stability” sit deep in a sea of myth and inadequate understanding about human movement, even in health and fitness spaces. I say this as a comprehensively trained Pilates teacher, osteopath and clinical educator with lived experience managing a severe spinal injury.
The area in the body that most folks are referring to when they say “core” is scientifically called the lumbopelvic-hip complex (LPHC). It’s the bit our head, arms, and legs attach to, also known as the torso or trunk. It often acts as a stabiliser and force transfer, for example; it stops folks from falling over while reaching on one leg high into the back of the cupboard for their secret chocolate stash; yikes, am I over-sharing? But you get the picture and might understand why you might have been advised to “work on your core stability, or “strengthen your core.”
Yet people focus on training it in isolation as a prime mover, with exercises like sit-ups, crunches, and planks, and while there is nothing wrong with those exercises if they are appropriate for you and your body. If that is all you do to “strengthen your core,“ you miss out on a significant aspect function and more efficient movement. Think of movement and exercise like food; the more variety, colour, texture and flavour, equals more nutrients.
In reality, most of us living in the developed world, need to add back the functional * closed chain movements missing from our daily lives. Hence the need to exercise in the first place, think of some aspects of exercise as a supplement to get the nutrients missing from your daily diet: squats, twists and overhead arm reaches.
Torso (core) stability has several components: motor control, strength, flexibility, function, and endurance, all of which should eventually be dynamic rather than static - sit-ups and planking. Motor control and function are the essential elements that provide the foundation for the remaining three.
Conventional approaches view muscles as having isolated actions and functions and propose that two distinct, interdependent muscular systems enable our bodies to maintain proper stabilisation and ensure efficient distribution of forces for the production of movement.
Muscles located more centrally to the spine are known as part of the stabilisation system and provide intersegmental stability, or vertebrae to vertebrae stability whereas muscles further away from the spine, are known as the global or movement system, and support the spine as a whole.
Training programs should be functional if at all possible, by that I mean movements based on real-life moves used in daily tasks at home, at work or in sports. They should include rotational movements, and pushing, pulling, lunging, and squatting. Plus multi-planar, multi-joint actions that place a demand on the body’s whole torso musculature, for example, squats with arm or head movement or with a load.
Where to start if you need or want to work on your trunk stabilisation (core)
It depends (sorry, it’s the standard osteopathic answer); some people need to release tight muscles first to create a window of opportunity to get flexible. Others might release tight muscles with a movement practice. Some find strength training is their best way forward and others need to begin with motor control due to injury or long term issues.
In my opinion, the approach “core” should be individually governed by need, preference and goals, physical and psychological, and from a place of understanding how humans move, rather than a prescription.
Most of the people I work with have multifactorial complex chronic presentations and fear moving sadly from misinformation from other professionals. Many believe that movement equals pain and pain equals harm. So being still /static equals safe, and the way to achieve that is to hold their core as tight as Beyonce’s abs.
Twenty years as a health and movement professional and 26 years of managing a complex and significant spinal injury and tons of gold standard research informs me there is no evidence that “core training protects the spine” and surrounding musculature from injury.
So, where would I start?
- For the folks I work with, motor control is the most helpful place to begin because it gives folks confidence, reduces the perception of motion (movement) and mobility, equalling pain or damage.
- Once the initial phase is working well, it’s time to move on to graded dynamic movements – get up and add variety.
- It’s essential to understand how to effectively and efficiently produce and transfer force with progressive, dynamic movements; without motor control, the other components such as “core bracing” are not, in my opinion, helpful.
Making exercise functional while keeping folks feeling stable and safe becomes a challenge that involves creativity and skill and a little kind of trickery. For example, demonstrating another way when people believe they have a weak core and feel the need to brace, suck or pull their belly in to pick up a bag of groceries from the boot of a car. Or their wriggling baby, from their car seat, that they can do these tasks more effectively and comfortably without this preparation.
Regardless of the specific exercise or movements utilised, training programs should be mindful of the patient/client/particular goals and be progressive. Slow, controlled, elementary exercises such as isometric transversus abdominis exercises and pelvic tilts may be the best starting level depending on the person’s level of pain, level of moving anxiety and fear avoidance. However, this is not universal ‘law’ or appropriate for all.
When folks can perform these exercises well and maintain a regular breathing pattern, it’s time to progress – moving on from a single plane to multi-plane movements, from isometric to concentric and eccentric contractions.
Multi-planar stability activities with one side of the body working independently of the other are the most functional because they offer dynamic movement of the body in three dimensions simultaneously. Activities such as running require controlling ground reaction forces, delivering propulsion forces, and the dynamic stabile movement of the body.
Except, most people in pain or with chronic problems are not going to running anywhere, so what are you going to do with them? Cat/ cow, bird /dog? What else? Rehabilitation therapists and movement coaches need to get people to work with variations in the speed of movements: slow to fast. Not an element used much in classic Pilates, but hopefully, one does not live life in one gear, so modern adaptions of the method [Pilates] have incorporated this.
Where to next? Isolated movements may be enough for targeting specific muscles, but the gains may not carry over into everyday life or sport. Plus, I don’t think muscle, but movement and joints. So starting without resistance and building to resisted movements is an option, adding limb movement another, and vary from lying-down positions to sitting and standing best.
Be patient; movement re-education exercises should progress only when the patient/client/you feel secure. Can maintain spinal stability with regular calm breathing – to reduce stress hormones.
This may take some time, patience, kindness, reassurance, and repetition, lots of repetition, especially in people with persistent pain histories, complex trauma or comorbidities, because they need to feel free from perceived or real danger. While you support them to explore the opportunities, risks, and benefits of new movements in unfamiliar positions, oh, and make it enjoyable, it’s going to be work. Still, in my opinion, too much of the rehabilitation journey is tedious, and it doesn’t have to be; make it playful if you can, ask for support if you can’t.
*Closed chain exercises are those performed where the hand or foot (extremity) is fixed and cannot move and remains in constant contact, usually with the ground or the base of an exercise machine.